Request to Baptize

Name of Child to be Baptized

Child's Date of Birth (YYYY-MM-DD)

City and State where Child was Born

Full Name of Child's Father

Full Name of Child's Mother (including Maiden Name)

Street Address, City, State, Zipcode

Telephone Number

Email Address

Name of Child's Godfather

Name of Child's Godmother

Date that you attended Baptism Preparation Class (YYYY-MM-DD)

Please check all of the following boxes that apply(required)

Parents of child married in the Church.

Father of the child is Catholic.

Mother of the child is Catholic.

Godfather of the child is Catholic and has received the Sacraments of Baptism/Eucharist/Confirmation/Marriage (if married).

Godmother of the child is Catholic and has received the Sacraments of Baptism/Eucharist/Confirmation/Marriage (if married).

Comments/Questions regarding status of Parents or Godparents

Date that you would like to baptize your child. (YYYY-MM-DD)

Any Comments/Questions/Concerns